Your desire to have children is important to both you and your partner. And while you work with your physician on developing a plan to reach that essential goal, you don't always have to take a backseat in the process, letting your doctor or "nature" take major plans of action. You can be just as proactive in your reproductive health. There is a wide range of factors involved in the process to pregnancy. And experts say that even one minor flaw in any of these processes can have a negative impact.
Acquiring 'Power Over the Process'
"Dealing with infertility is draining, from a mental, physical, and emotional standpoint," said Mark Leondires, MD, Medical Director of Reproductive Medicine Associates of Connecticut in Norwalk, Connecticut. "By providing five simple ways that men and women can determineâ€”and enhanceâ€”their own fertility levels, I hope to give them back a sense of power over the process."
There are ways to be proactive, involving your own self-assessment of your fertility potential, which can then be incorporated into your reproductive health status:
1. The Biological Clock
Women are born with all the eggs that they will ever have. 1 Additionally, the vast majority of these eggs never mature, and of those that do, their quality and quantity diminish with age. That said, while younger women are considered infertile if they haven't gotten pregnant after 1 year of unprotected intercourse, that timeframe is shortened to 6 months in women over age 35. "At 35 and above, we know that pregnancy rates go down," explained Spencer Richlin, MD, a reproductive endocrinologist at Reproductive Medicine Associates of Connecticut. "So we don't want people to wait too long because we really would like to do an evaluation to make sure there are no issues that are going on."
Primarily, infertility evaluations involve the health of the fallopian tubes, sperm, and an ovarian reserve assessment (an egg quality test), Richlin explained. The latter test consists of a blood sample collected on day 3 of a woman's cycle to assess levels of follicle stimulating hormone (FSH). This is a hormone released by the pituitary gland early in a woman's cycle to stimulate ovulation. If the ovaries don't respond, the pituitary gland releases more FSH; thus, a higher FSH level indicates ovulation difficulties. 2 In cases in which elevated FSH levels reach a certain threshold, studies have suggested that the odds of pregnancy can be less than 1%, even with assisted reproduction, Richlin pointed out. At that point, his clinic offers patients the option of a donor egg pregnancy, he said. "We have a live birth rate with a donor egg of 70%."
2. Ovulation Self-Assessment
The typical menstrual cycle lasts from 21 to 40 days, varying from woman to woman. 3 However, if yours is shorter or longer, it's possible that you're not ovulating, experts say. And you can determine this yourself by using a reliable test known as an Ovulation Predictor Kit, which aids in timing intercourse properly. It can be purchased from any local pharmacy and detects hormone levels in urine. The test is taken fairly early in the cycle. If two lines are seen on the special stick used in the kit, it indicates a luteinizing hormone (LH) surge is taking place and that intercourse should take place the next dayâ€”the most fertile day in the cycleâ€”to boost the odds of pregnancy, Richlin said.
The other optionâ€”though used much less frequentlyâ€”is known as basal body temperature, in which a woman takes her temperature each day and notes it on a special chart over the course of several months. "The basal body temperature will typically dip in mid-cycle, then spike and remain higher until menstruation," said Leondires. "The dip and spike usually indicate ovulation."
3. Fallopian Tube Assessment
The fallopian tubes are the only route between the ovaries and uterus, and they're typically the area in which sperm fertilize an egg. However, if one or both tubes are blocked, conceiving will likely be much more difficult. Knowing that, women should advise their doctors of any previous circumstances that might indicate a tubal blockage, said Richlin. About 35 percent of his patients will have an infertility cause due to uterine or fallopian tube complications, he pointed out.
"What we often do [to assess that] is the hysterosalpingogram [HSG]. It's an x-ray dye test that tells us if the tubes are open and if the uterine cavity is normal in shape," he told Priority Healthcare. A catheter is inserted into the cervix, and dye is subsequently funneled through the cervix into the fallopian tubes. It is monitored during this process to determine if there are any blockages.
While the test is very reliable, knowing a woman's history will aid in that evaluation. Previous pelvic infection, tubal pregnancy, abdominal surgery or a ruptured appendix raise the odds of a damaged fallopian tube, Leondires said.
Other possible risks that may prompt an HSG include pelvic pain or an endometriosis diagnosis, added Richlin.
4. Importance of Timing
Timing is everything in planning pregnancy. According to Leondires, up to one-fifth of couples miscalculate the optimal time for conception. Thus, he suggests subtracting 17 days from the average number of days in your cycle, then having intercourse on that day and two days later. You can determine the number of days in your cycle by counting the numbers of days between your periods.
Richlin adds that since ovulation typically occurs in mid-cycle, it's best to have intercourse on or around that time. "That's potentially the most fertile time," he said. Using the example of a 28-day cycle, ovulation would occur on or near day 14. Thus, to cover that 'window of opportunity,' it's best to have intercourse on days 11, 13 and 15. "We know sperm lasts in the cavity a couple of days, so [by doing that,] they've covered the time that they're most likely ovulating," Richlin said.
5. Male Factor Infertility
A male cause of infertility is confirmed in about 35% of cases, said Richlin. So, it's important to discuss any relevant medical history with your doctor. For example, reproductive surgery, history of infection, a mumps diagnosis, excessive alcohol or drug use, or close contact with industrial chemicals can boost the odds of a male infertility factor, said Richlin. When a male cause is suspected, a semen analysis is then typically ordered. A 'normal' semen analysis consists of a minimum of 20 million sperm per milliliter of semen. Additionally, at least half should have adequate motilityâ€”the ability to move spontaneouslyâ€”as well as a healthy morphology, or appearance, Richlin explained.
1. Perez GI, Robles R, Knudson CM, Flaws JA, Korsmeyer SJ, Tilly JL. Prolongation of ovarian lifespan into advanced chronological age by Bax-deficiency. Nat Genet 1999 Feb;21(2):200-3.
2. Fertility Neighborhood. Ovarian Reserve Testing. Available at: http://www.fertilityneighborhood.com/content/understanding_infertility/
diagnosing_female_infertility_133.aspx. Accessed May 10, 2005.
3. The Merck Manual. Menstrual Cycle. Available at: http://www.merck.com/mmhe/sec22/ch241/ch241e.html?qt=ovulation&alt=sh. Accessed May 10, 2005.
John Martin is a long-time health journalist and an editor for Priority Healthcare. His credits include coverage of health news for the website of Fox Television's The Health Network, and articles for the New York Post and other consumer and trade publications.
Good article. May I suggest a resource? If you are trying to conceive you might consider using a personal ovulation test. The are not very expensive and you can find them at drugstores or online at
http://www.personalovulationtest.com I hope this is hellpful!
This is a great resource for women/men who are wondering why they are not conceiving. It is always best to know which fertility questions/issues to consider before going in to the doctor. This way you are informed and not completely lost.